AIM:
The study aimed at describing contributing factors for the progression or regression of pressure ulcers in the care trajectory as they were understood by nurses working in hospitals or community care.
BACKGROUND:
The development of pressure ulcers is considered to be connected with early prevention and awareness among nurses and some studies have indicated that the care trajectory may be a weak point.
DESIGN:
The study was carried out with a qualitative design.
METHOD:
Fifteen nurses from two Swedish hospitals and 15 nurses from community care were interviewed during 2005. Qualitative content analysis was used to make an understanding of patterns possible.
FINDINGS:
Three main categories arose, showing that pressure ulcers were considered to be affected in the care trajectory by factors related to the individual patient, to the healthcare personnel and to the healthcare structure. Hospital and community care nurses mostly had corresponding perceptions of these factors.
CONCLUSION:
The study both confirmed previous findings and added new knowledge about factors that may affect pressure ulcer in the trajectory of care. The informants' views of nurses' responsibilities and their attitudes towards the care of pressure ulcers could, along with their views on the organisation of care, increase the understanding of the occurrence of pressure ulcers. The need for development and clarification of the organisation and responsibility of pressure ulcer care in the care trajectory was stressed. Relevance to clinical practice. The study highlighted attitudes and values among registered nurses, as well as to how to preserve their commitment and increase their knowledge concerning prevention of pressure ulcers.
Aim. This paper reports on a study of how clients experience living with home mechanical ventilation and how they experience care and supervision of healthcare personnel.
Background. The number of people living at home with mechanical ventilators is increasing, and this is considered a successful approach to reducing incapacity and mortality.
Method. Qualitative interviews were conducted with 10 service users in 2006. The informants were 18–75 years old and had varying diagnoses and levels of functioning. The interviews were tape recorded, transcribed and analysed by qualitative content analysis.
Findings. Two main themes emerged: Theme 1. Having a home ventilator enhances quality of life – a life worth living. The ventilator treatment builds up strength and improves well-being. Participants emphasized that it was important to feel in control of their own situation and had an overriding wish to live a normal and active life; Theme 2. Competence and continuity of healthcare personnel are factors for success. The experience was that competence and follow-up by healthcare personnel varied, and that good quality teaching and information were important.
Conclusion. Users of home mechanical ventilators should be active partners in their own care so that their experience is taken into account. It is important for clients having home mechanical ventilation to be empowered and have control in their daily lives, as well as having competent caregivers and continuity of care.
Conditions for nurses' daily patient education work are unclear and require clarification. The aim was to develop and validate the Nurses' Patient Education Questionnaire, a questionnaire that assesses nurses' perceptions of appropriate conditions for patient education work: what nurses say they actually do and what they think about what they do. The questionnaire was developed from a literature review, resulting in the development of five domains. This was followed by 'cognitive interviewing' with 14 nurses and dialogue with 5 pedagogical experts. The five domains were identified as significant for assessing nurses' beliefs and knowledge; education environment; health care organisation; interdisciplinary cooperation and collegial teamwork; and patient education activities. A content validity index was used for agreement of relevance and consensus of items by nurses (n = 10). The total number of items in the final questionnaire is 60, consisting of demographic items, what nurses report they do and perceptions about patient education in daily work. The questionnaire can be used by managers and nurses to identify possibilities and barriers to patient education in different care contexts.
Background: Scientific knowledge is expected to be used in clinical practice to ensure that patients are given evidence-based nursing care. Therefore, in order to improve nurses’ research utilisation in clinical practice a network had been provided for nurses especially interested in nursing development in eleven wards. These nurses were expected to take on the role of key person (facilitator) for nursing development in clinical practice.Aim: The study was aimed at describing nurses’ interest in nursing research, how network support to ‘facilitator nurses’ could improve development in patient care based on evidence, and what hindering factors for such development could be.Methods: One and a half years after onset of the project a follow-up study was conducted with a questionnaire answered by 75 (64%) nurses, and group interviews with nine facilitators and eleven head nurses.Findings: The nurses’ interest in research utilisation was in general high and in eight wards development work had started. The facilitator nurses had mostly worked without involving their colleagues. Hindering factors for nursing development were related to time, EBP knowledge, involvement and the interest of head nurses and colleagues. Education, work place, previous participation in research projects, and participation in the network impacted positively on nurses’ attitudes to and interest in research.Conclusion and implication for clinical practice: Providing networks to ‘facilitator nurses’ in the ward could be useful for developing nursing care based on research findings. However, support from nurse leaders, involvement of the whole nursing staff, and training in research utilisation are important factors for success.
BACKGROUND:Delirium is common among older people in hospital and various instruments have been developed for detecting delirium. One of these, the NEECHAM Confusion Scale, is easy for nurses to administrate but needs to be tested further.
AIMS AND OBJECTIVES:The aim of the present study was to assess the validity and predictive value of the NEECHAM Confusion Scale.
METHODS:The study was conducted among 149 patients aged ≥ 65, who had undergone surgery for a hip fracture. The patients were observed daily using DSM-IV criteria for delirium. The NEECHAM Confusion Scale was performed upon admission and prior to discharge.
RESULTS:The incidence of DSM-IV related delirium was 24%. Patients who scored below 25 points on the NEECHAM scale had a 12 times higher risk of developing DSM-IV related delirium. During admission, the sensitivity of NEECHAM was zero because all patients with DSM-IV delirium were excluded, the specificity was 75%. On discharge, it was 100% and 91% respectively.
CONCLUSIONS:This study adds to the body of knowledge that NEECHAM discriminates for delirium. It is a valid and reliable screening instrument for predicting delirium. The instrument can be used for clinical practice to identify patients who are at risk of contracting delirium and when considering prevention measures.
Most studies concerning older people’s health and well-being have focused on their ill health, disease and complaints and have mainly been conducted with a quantitative design. Hence, there is still a need for qualitative studies in which these peoples’ own views on health and well-being are shown, especially when they are dependent on health care in a community setting. A qualitative approach was used in the study reported here and aimed at obtaining a deeper understanding of older peoples’ own views about their health and well-being. Interviews were carried out on two occasions with 19 older people living in their own homes and in sheltered accommodation. The data were analysed using content analysis. The findings suggested that the possibility to feel healthy was dependent both on the older person’s own ability to adjust or compensate to their situation, and on how their caregivers, relatives and friends could compensate for the obstacles the older person faced. The subcategories that captured the informants’ experiences of health and ill health were described as positive and negative poles of autonomy, togetherness, tranquillity and security in daily life. The significance of the caregivers was clearly evident. Their competence, commitment and treatment were prerequisites for the older person’s ability to experience health in spite of being dependent on care.
In spite of a considerable body of research in the past decades on what does or does not constitute good care for older people, there are still few studies addressing this question in which older people narrate their experiences of being dependent on community care. This study was therefore carried out aiming to explore older people's lived experiences of what good and bad care meant to them, when it was offered by community care services. Nineteen older persons in three Swedish communities participated in the study, which used a phenomenological-hermeneutic approach. Data were collected through unstructured interviews and Colaizzi's framework was utilized in the analysis of the data.The key theme arising from the analysis was that of being encountered as a human being by caregivers who, through the provision of safe and secure care, provide opportunities for living life as usual. When any of these circumstances are lacking, bad care will be the consequence. As the general intention in society is to ensure good quality of care to older people as well as others, the findings in our study should have important implications for providers of community care for older people.
Background
Despite the growing number of studies concerning quality of care for older people, there is a lack of studies depicting factors associated with good quality of care from the formal caregivers’ perspective. The aim was to describe formal caregivers’ perceptions of quality of care for older people in the community and explore factors associated with these perceptions. In total, 70 nursing assistants, 163 enrolled nurses and 198 registered nurses from 14 communities in central Sweden participated in the study. They filled out the following questionnaires: a modified version of Quality from the Patient’s Perspective, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items regarding education and competence, Health Index and Sense of coherence questionnaire. The overall response rate was 57 % (n = 431).
Results
In the perceived reality of quality of care respondents assessed the highest mean value in the dimension medical-technical competence and physical technical conditions and lower values in the dimensions; identity-oriented approach, socio-cultural atmosphere and in the context specific dimension. The caregivers estimated their competence and health rather high, had lower average values in sense of coherence and organizational climate and low values in stress of conscience.
Conclusions
The PR of quality of care were estimated higher among NA/ENs compared to RNs. Occupation, organizational climate and stress of conscience were factors associated with quality of care that explained 42 % of the variance. Competence, general health and sense of coherence were not significantly associated to quality of care. The mentioned factors explaining quality of care might be intertwined and showed that formal caregivers’ working conditions are of great importance for quality of care.
AimThe aim of the study was to investigate: acute confusional states, pain and pain relief, physical health, psychological well-being and functional status among patients with hip fracture during hospital stay. A further aim was to describe patient's perceptions of quality of care.
MethodForty-nine patients with hip fracture ⩾70 years old were consecutively included in the study at two hospitals in Sweden. Data were collected by interview and observation using structured questionnaires at four occasions.
ResultsThe incidence of acute confusion was 32% on admission and the day after surgery and 14% the day before discharge. Additional diagnosis and on-going medication were significantly more common among confused patients. Patients with confusion experienced more intense pain at rest on admission and the day before discharge than non-confused patients. On perceived reality in quality of care patients' reported most favourable scores with regard to respect and empathy from the nurses and less favourable scores with regard to the information of responsible persons and information after procedures. The overall subjective importance of quality of care was higher than on the perceived quality of care.
ConclusionMore attention, systematic observations and preventive actions should be taken when there are signs of acute confusion, pain and pain relief among patients with hip fracture. Patients' ratings of the subjective nature of care were higher than the perceived reality of quality of care and needs to be given attention since subjective importance reflects how the patients want their care to be.